Is peer support in group clinics as effective as traditional individual appointments? The first study in patients with coeliac disease

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For newly-diagnosed patients with coeliac disease (CD), adherence to a gluten-free diet (GFD) can be challenging. Therefore, it is important that these patients are seen by a dietitian to help educate them on a balanced, nutritionally adequate GFD. In the UK, there appears to be many centres providing an inadequate level of support for these patients as suggested in UK clinical guidelines. Dietetic group clinics have been proposed as new way to manage patients with CD with potential benefits including peer support and standardising dietetic care. This study aimed to assess the outcomes of a novel set-up of group clinics in comparison with one-to-one consultations in this patient group.

A total of 60 newly diagnosed adult patients with CD participated in the study. Of these, 30 patients were educated in group consultations with an average of 6 patients, and 30 patients received individual appointments. In addition to coeliac antibody values, bloods were undertaken in line with the British Society of Gastroenterology (BSG) guidelines, including micronutrient levels. These were assessed at both baseline and after three months. Validated questionnaires, including the Short-Form 36 (SF-36) survey and the Hospital Anxiety and Depression Score (HADS) were also completed. In addition, a validated questionnaire (Biagi score) assessing adherence was also performed at 3 months.

A significant reduction in tissue transglutaminase (tTG) was observed in all patients along with an increase in certain micronutrient levels. There were no significant differences in the baseline or follow-up biochemical parameters in patients seen in group clinics or individual consultations. In addition, no difference in adherence scores between the two groups was seen. The HADS Anxiety Score was found to be higher in group clinics compared with one-to-one consultations at follow-up. The estimated time saving for dietetic professionals of the group clinic approach was found to be 28 hours (54% reduction).

This study found group clinics to be as effective as one-to-one consultations in the delivery of dietetic advice for CD patients. Similar adherence levels were observed along with improvement in serological markers in both groups. Nutritional and quality of life (QOL) measures were also found to be similar between the groups. In addition, there are added benefits to this approach including peer support and time savings for dietitians. It is important to note that this study only followed these patients up for 3 months and therefore whether these findings would be maintained at a longer follow-up period should be questioned.

Rej, A., Trott, N., Kurien, M., Branchi, F., Richman, E., Subramianian, S. & Sanders, D. (2020): Is Peer Support in Group Clinics as Effective as Traditional Individual Appointments? The First Study in Patients With Celiac Disease. Clinical and Translational Gastroenterology. 11(1). doi: 10.14309/ctg.0000000000000121.